Effect of decompression range on decompression limit of cervical laminoplasty.

BACKGROUNDS: Cervical posterior decompression surgery is used to relieve ventral compression indirectly by incorporating a backward shift of the spinal cord, and this indirect decompression is bound to be limited. This study aimed to determine the decompression limit of posterior surgery and the effect of the decompression range. METHODS: We retrospectively reviewed the data of 129 patients who underwent cervical open-door laminoplasty through 2008 to 2012 and were grouped as follows: C4-C7 (n = 11), C3-C6 (n = 61), C3-C7 (n = 32), and C2-C7 (n = 25). According to the relative location of spinal levels within a decompression range, the type of decompression at a given level was categorized as external decompression (ED; achieved at the levels located immediately external to the decompression range margin), internal decompression (ID; achieved at the levels located immediately internal to the decompression range margin), and central decompression (CD; achieved at the levels located in the center, far from the decompression range margin). The vertebral-cord distance (VCD) was used to evaluate the decompression limit. The C2-C7 angle and VCD on post-operative magnetic resonance images were analyzed and compared between groups. The relationship between VCD and decompression type was analyzed. Moreover, the relationship between the magnitude of the ventral compressive factor and the probability of post-operative residual compression at each level for different decompression ranges was studied. RESULTS: There was no significant kyphosis in cervical curvature (> -5°), and there was no significant difference among the groups (F = 2.091, P = 0.105). The VCD of a specific level depended on the decompression type of the level and followed this pattern: ED < ID < CD (P < 0.05). The decompression type of a level was sometimes affected by the decompression range. For a given magnitude of the ventral compressive factor, the probability of residual compression was lower for the group with the larger VCD at this level. CONCLUSIONS: Our study suggests that the decompression range affected the decompression limit by changing the decompression type of a particular level. For a given cervical spinal level, the decompression limit significantly varied with decompression type as follows: ED < ID < CD. CD provided maximal decompression limit for a given level. A reasonable range of decompression could be determined based on the relationship between the magnitude of the ventral compressive factor and the decompression limits achieved by different decompression ranges.

[Etiological analysis, preventional and therapeutical strategies for the unsatisfied cervical posterior decompression surgery].

OBJECTIVE: To discuss the causes of unsatisfied cervical posterior decompression surgery and describe the overhauling strategies and precaution. METHODS: The clinical data of 14 patients required revision surgery were retrospectively analyzed, and these patients with unsatisfied effects were due to cervical posterior decompression surgery from January 2012 to December 2014. Overhauling reasons were analyzed and then different revision procedures were performed. The functions of cervical cord and ambulation were evaluated respectively by modified Japanese Orthopedic Association(mJOA) score and Nurick grade according to the course order:preoperative for the first time, pre-revision and at final follow-up. Improvement rate of nerves function were calculated before and after operation for the first time, before and after revision. Above data were statistically analyzed by SPSS16.0 software. RESULTS: Reoperation reasons including 2 patients with the insufficiency width of laminectomy, 2 patients with the inadequate length of decompression, 2 patients with nerve root and spinal cord compression caused by fractured collapse, 4 patients with closed the door of vertebral lamina, 1 patient with less open-door angle, 2 patiens with ossification of posterior longitudinal ligament (1 case complicated with close the door), 2 patients with cervical spine kyphotic deformity aggravating (1 case complicated with close the door), 1 patient with nerve root canal stenosis caused by uncovertebral joint hyperplasia. Preoperative for the first time, pre-revision and at final follow-up, mJOA scores were 11.89±1.67, 13.11±1.09, 15.61±0.59, and Nurick grades were 4.21±0.58, 3.57±0.51, 1.71±0.47, respectively. There was significant difference between final follow-up and preoperative for the first time, pre-revision(P<0.05). Improvement rate of nerve function was (22.33±9.49)% with bad before and after operation for the first time, and (64.60±9.88)% with good before and after revision, with statistical significance(P<0.05). CONCLUSIONS: Individualized revision surgery based on different causes for unsatisfied cervical posterior decompression can improve the function of spinal cord. Preoperative carefully analyzing the etiological factors, thoroughly decompression can reduce the revision rate.

Laminoplasty with lateral mass screw fixation for cervical spondylotic myelopathy in patients with athetoid cerebral palsy: A retrospective study.

Although several studies report various treatment solutions for cervical spondylotic myelopathy in patients with athetoid cerebral palsy, long-term follow-up studies are very rare. None of the reported treatment solutions represent a gold standard for this disease owing to the small number of cases and lack of long-term follow-up. This study aimed to evaluate the outcomes of laminoplasty with lateral mass screw fixation to treat cervical spondylotic myelopathy in patients with athetoid cerebral palsy from a single center.This retrospective study included 15 patients (9 male patients and 6 female patients) with athetoid cerebral palsy who underwent laminoplasty with lateral mass screw fixation for cervical spondylotic myelopathy at our hospital between March 2006 and June 2010. Demographic variables, radiographic parameters, and pre- and postoperative clinical outcomes determined by the modified Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and visual analog scale (VAS) scores were assessed.The mean follow-up time was 80.5 months. Developmental cervical spinal canal stenosis (P = 0.02) and cervical lordosis (P = 0.04) were significantly correlated with lower preoperative modified JOA scores. The mean modified JOA scores increased from 7.97 preoperatively to 12.1 postoperatively (P < 0.01). The mean VAS score decreased from 5.30 to 3.13 (P < 0.01), and the mean NDI score decreased from 31.73 to 19.93 (P < 0.01). There was a significant negative correlation between developmental cervical spinal canal stenosis and recovery rate of the modified JOA score (P = 0.01).Developmental cervical spinal canal stenosis is significantly related to neurological function in patients with athetoid cerebral palsy. Laminoplasty with lateral mass screw fixation is an effective treatment for cervical spondylotic myelopathy in patients with athetoid cerebral palsy and developmental cervical spinal canal stenosis.

Novel deletion mutation of TRPS1 gene in a Chinese patient of trichorhinophalangeal syndrome type I.

Tricho-rhino-phalangeal syndrome (TRPS) is a rare autosomal dominant disorder. Deletion or mutation of the TRPS1 gene leads to the tricho-rhino-phalangeal syndromes type I or type III. In this article, we describe a Chinese patient affected with type I TRPS and showing prominent pilar, rhinal and phalangeal abnormalities. Mutational screening and sequence analysis of TRPS1 gene revealed a previously unidentified four-base-pair deletion of nucleotides 1783-1786 (c.1783_1786delACTT). The mutation causes a frame shift after codon 593, introducing a premature stop codon after 637 residues in the gene sequence. This deletion is an unquestionable loss-of-function mutation, deleting all the functionally important parts of the protein. Our novel discovery indicates that sparse hair and metacarpal defects of tricho-rhino-phalangeal syndromes in this patient are due to this TRPS1 mutation. And this data further supports the critical role of TRPS1 gene in hair and partial skeleton morphogenesis.

[Reoperation to the ossification of the posterior longitudinal ligament].

OBJECTIVE: To discuss surgical approaches of ossification of the posterior longitudinal ligament (OPLL) of cervical spine. METHODS: Between June 2005 to July 2010, 36 patients with OPLL of cervical spine were reoperated. There were 23 male, 13 female, age from 39 to 72 years (mean 57 years). The time of the first operation to the reoperation were 4 months to 24 years, an average of 3.9 years. Among 20 patients underwent anterior corpectomy and fusion (ACD) at first operation, 14 cases combined stenosis of cervical spinal canal, 10 cases were insufficient decompression of OPLL, 5 cases injured of cervical spinal cord during the first operation, 1 case was adjacent disc herniation. Among 14 cases underwent expensive open-door laminoplasty (ELAP) at first operation, 6 cases were insufficient decompression of OPLL, 4 cases were inadequate decompressed segment, 2 cases were cervical segmental kyphosis, 2 cases were progression of OPLL combined with disc herniation. Among 2 cases underwent combined approach at first operation, 1 case was insufficient decompression of OPLL, the other was adjacent disc herniation. Their pre- and post-operative X-ray, CT and MRI were analyzed. The complications of reoperation were recorded. RESULT: There were 30 patients followed-up, with a period of 1.5 - 4.0 years, average 1.8 years. With 36 patients, none had deterioration, 2 patients had no recovery post-reoperation, 34 patients had 31.2% Japanese Orthopedic Association score improve rate. Among 22 cases underwent ELAP at second operation, 3 cases had postoperative segmental palsy. Among 14 cases underwent ACD at second operation, 3 cases had intraoperative dural defects. CONCLUSION: Surgical strategy for OPLL of cervical spine should consider the type of OPLL and stenosis of cervical spinal canal.

Negative relationship between expression of glucocorticoid receptor alpha and disease activity: glucocorticoid treatment of patients with systemic lupus erythematosus.

OBJECTIVE: Glucocorticoid receptor alpha (GRalpha) is crucial for glucocorticoids (GC) to carry out their physiological and pharmacological roles. Studies have shown the disorder of GR-GC systems in autoimmune diseases. Our study was performed to test the relationship between GRalpha expression and disease activity of systemic lupus erythematosus (SLE). METHODS: The responses of 55 patients with SLE to GC were screened. We examined GRalpha mRNA and protein expression in peripheral blood mononuclear cells from SLE patients and healthy volunteers by reverse transcriptase-polymerase chain reaction and Western blotting. RESULTS: Expression of GRalpha in patients with SLE was lower than that in controls (p < 0.05). Expression of GRalpha obviously decreased after administration of GC in the steroid-sensitive group with SLE (p < 0.05). Expression of GRalpha was negatively correlated with SLE Disease Activity Index scores in the steroid-sensitive group with SLE. CONCLUSION: The expression of GRalpha in patients with SLE was low and there was a negative correlation between GRalpha expression and disease activity; these findings might provide insight into the pathogenesis of SLE and help to screen whether the patient is sensitive to GC treatment. (Heilungkiang Provincial Health Department Guiding Projects Funding. Trial registration No. 2006-094.).

Dual role of shikonin in early and late stages of collagen type II arthritis.

OBJECTIVE: To investigate the anti-inflammatory or immunomodulatory effect of shikonin on early stage and established murine collagen-induced arthritis (CIA). METHODS: Mouse were injected intraperitoneally with shikonin (5 mg/kg) for 10 days along before or after the onset of CIA. The arthritis response was monitored visually by macroscopic scoring. Reverse transcription-polymerase chain reaction and western blotting were employed to determine the mRNA and protein expression of cytokine in patella with adjacent synovium in CIA mouse. Histology of knee was used to assess the occurrence of cartilage destruction and bone erosion. RESULTS: Shikonin (5 mg/kg) treatment along had no effect on macroscopic score and incidence of arthritis on early stage of CIA. However, a pronounced amelioration of macroscopic score and cartilage destruction was found in mouse treated with shikonin on established CIA for 10 days. Moreover, The mRNA levels of Th1 cytokines [tumor necrosis factor-alpha and interleukin (IL)-12] was significantly inhibited both in the synovial tissue and in the articular cartilage in treated groups compared with those in control groups, whereas the mRNA and protein levels of Th2 cytokines (IL-10 and IL-4) remained elevated throughout the treatment period. Moreover, the inflammatory cytokine, the mRNA and protein levels of IL-6 was down-regulated in mice with established CIA after treatment with shikonin. T-box expressed in T cells (T-bet) mRNA levels were decreased in shikonin compared with control group, and GATA-3 mRNA levels were higher than that in control group. CONCLUSION: Shikonin treatment on established CIA can inhibit Th1 cytokines expression and induce Th2 cytokines expression in mice with established CIA. The inhibited effect of shikonin on Th1 cytokines expression may be mediated not only by inhibiting Th1 responses through T-bet mechanism, but also by inducing anti-inflammatory mediators such as IL-10 and IL-4 through a GATA-3 dependent mechanism.

[Immunoregulatory effect of bone marrow mesenchymal stem cells on regulatory T cells in patients with systemic lupus erythematosis].

OBJECTIVE: To study the in vitro modulation of autogeneic and allogenic regulatory T lymphocytes proliferation by bone marrow mesenchymal stem cells (MSCs) in patients with systemic lupus erythematosis (SLE). METHODS: Human MSCs were separated with Percoll (1.073 g/ml) from bone marrow of patients with SLE or healthy subjects. The purity of MSCs was identified with the phenotypes by fluorescence active cell sorter (FACS). The subset regulatory T cells in the peripheral blood of patients with SLE were isolated with magnetic activated cell sorting (MACS) CD4 and CD25 microbeads. Lymphocytes or CD4+ CD25+ T cells isolated from the peripheral blood of SLE patients were cocultured either with autologous MSCs or MSCs from healty donors. The proliferation activities of lymphocytes and CD4+ CD25+ T cells were investigated with methyl thiazolyl tetrazolium( MTr) test. The level of IL-10 and transforming growth factor beta (TGFbeta) was determined with enzyme-linked immunosorbent assay (ELISA). RESULTS: The lymphocyte activity in SLE was suppressed by autogeneic and allogeneic MSCs and the inhibition rate was 56.32% and 65.46%, respectively. A stronger immunosuppressive effect of allogeneic MSCs was detected. MSCs were capable of increasing the proportion of allogeneic and autogeneic regulatory T cells in a dose dependent fashion. MSCs stimulated CD4+ CD25+ T cells to produce IL-10 and TGFbeta. CONCLUSION: MSCs can suppress lymphocyte proliferation and increase CD4+ CD25+ T cells. MSCs might play important roles in immunosuppressant lymphocyte proliferation and be important to cooperate with autogeneic hematopoietic stem cells in transplantation.

[Treatment of proliferative lupus nephritis with leflunomide and steroid: a prospective multi-center controlled clinical trial].

OBJECTIVE: Leflunomide (LEF) is a selective inhibitor of de novo pyrimidine synthesis, currently used in the treatment of rheumatoid arthritis. To evaluate the efficacy and safety of LEF in the treatment of proliferative lupus nephritis, a prospective multi-center controlled clinical trial was conducted. METHODS: Patients with biopsy-confirmed proliferative lupus nephritis were recruited. Patients of recent onset who had not used any immunosuppressive drug were given either oral LEF (group A) or IV cyclophosphamide (group B); relapsed patients who had received immunosuppressive therapy 3 months before were given LEF (group C). Efficacy and safety were evaluated at 6 months after treatment. RESULTS: Total 51 patients were enrolled, 4 patients withdrew due to adverse events. For those initial treated patients, total response rate were 80% in group A and 75% in group B, complete remission rate were 40% and 25% respectively, not statistically different. Renal parameters (proteinuria, serum albumin and serum creatinine) and systemic lupus erythematosus disease activity index (SLEDAI) improved similarly in both groups. For 14 relapsed patients, total response rate was 60% and complete remission rate was 6.7%. Major adverse events reported in LEF treated patients were infection and alopecia. Herpes zoster was the most often type among infectious events, and one case of severe lung infection was reported. CONCLUSION: LEF combined with steroid was effective in the induction therapy of proliferative lupus nephritis. LEF was generally well-tolerated, its efficacy in maintenance therapy and long-term safety remains to be clarified.

[A prospective randomized comparison between with or without instrumentation in short-level anterior discectomy and autograft bone fusion].

OBJECTIVE: To evaluate anterior cervical plating in short-level anterior discectomy and autograft bone fusion. METHODS: Eighty-one patients who underwent one- and two-level anterior cervical discectomy and fusion were randomized to 2 groups, with or without instrumentation. Among them, 55 patients were followed up. The mean follow-up time was (22 +/- 7) months. Fusion rate, disc height and cervical lordotic alignment were assessed by radiographs. RESULTS: The improving rates were 68% in non-instrumented group and 58% in instrumented group, respectively (P > 0.05). The fusion rate was 93% in the non-instrumented group and 100% in the later one. The disc height was decreased (0.7 +/- 1.0) mm in the former group and increased (1.2 +/- 0.6) mm in the later one (P < 0.01). Although the postoperative cervical lordotic alignment was maintained better in instrumented group, the difference was not significant. CONCLUSION: Anterior cervical plating can make good influence on the result of anterior cervical discectomy and fusion in some degree.